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Published on: February 28, 2012
Implantable cardioverter-defibrillator therapy in Brugada syndrome: a 20-year single-center experience
Giulio Conte1, Juan Sieira1, Giuseppe Ciconte1
1Heart Rhythm Management Centre UZ Brussel-VUB, Brussels, Belgium.
Insights
Implantable cardioverter-defibrillator (ICD) therapy effectively treated ventricular arrhythmias in Brugada syndrome patients. However, appropriate shocks occurred in asymptomatic individuals, and inappropriate shocks and device complications remain significant concerns.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Brugada syndrome patients with syncope or aborted sudden cardiac death face high ventricular arrhythmia (VA) risks, necessitating implantable cardioverter-defibrillator (ICD) consideration.
- Management of asymptomatic Brugada syndrome patients with ICDs is debated due to risks of inappropriate shocks and device complications.
Purpose of the Study:
- To evaluate the clinical characteristics, management strategies, and long-term outcomes of ICD therapy in Brugada syndrome patients.
- To identify predictors of appropriate ICD shocks and assess the incidence of complications.
Main Methods:
- Retrospective analysis of 176 Brugada syndrome patients with spontaneous or drug-induced type 1 ECG findings who received ICDs.
- Continuous follow-up to assess for ventricular arrhythmias (VAs), appropriate/inappropriate shocks, electrical storm, and device-related complications.
Main Results:
- During 83.8 months of follow-up, 17% of patients experienced spontaneous sustained VAs, with 15.9% receiving appropriate ICD shocks.
- Inappropriate shocks affected 18.7% of patients, and 15.9% had device-related complications.
- Aborted sudden cardiac death and VA inducibility on electrophysiologic studies independently predicted appropriate shocks.
Conclusions:
- ICD therapy is effective for Brugada syndrome, managing life-threatening arrhythmias in 17% of patients over the long term.
- Appropriate shocks occurred in both symptomatic and asymptomatic patients, highlighting the need for careful risk stratification.
- High rates of inappropriate shocks and device complications persist, underscoring the complexities of ICD management in Brugada syndrome.
Background:
Patients with Brugada syndrome and aborted sudden cardiac death or syncope have higher risks for ventricular arrhythmias (VAs) and should undergo implantable cardioverter-defibrillator (ICD) placement. Device-based management of asymptomatic patients is controversial. ICD therapy is associated with high rates of inappropriate shocks and device-related complications.
Objectives:
The objective of this study was to investigate clinical features, management, and long-term follow-up of ICD therapy in patients with Brugada syndrome.
Methods:
Patients presenting with spontaneous or drug-induced Brugada type 1 electrocardiographic findings, who underwent ICD implantation and continuous follow-up at a single institution, were eligible for this study.
Results:
A total of 176 consecutive patients were included. During a mean follow-up period of 83.8 ± 57.3 months, spontaneous sustained VAs occurred in 30 patients (17%). Eight patients (4.5%) died. Appropriate ICD shocks occurred in 28 patients (15.9%), and 33 patients (18.7%) had inappropriate shocks. Electrical storm occurred in 4 subjects (2.3%). Twenty-eight patients (15.9%) experienced device-related complications. In multivariate Cox regression analysis, aborted sudden cardiac death and VA inducibility on electrophysiologic studies were independent predictors of appropriate shock occurrence.
Conclusions:
ICD therapy was an effective strategy in Brugada syndrome, treating potentially lethal arrhythmias in 17% of patients during long-term follow-up. Appropriate shocks were significantly associated with the presence of aborted sudden cardiac death but also occurred in 13% of asymptomatic patients. Risk stratification by electrophysiologic study may identify asymptomatic patients at risk for arrhythmic events and could be helpful in investigating syncope not related to VAs. ICD placement is frequently associated with device-related complications, and rates of inappropriate shocks remain high regardless of careful device programming.
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